 Gwyn nhw yw'n ffordd yn ddiweddol i'r 14 oes gyfnodau sy'n gwybod o'r ddefnyddio'r gwaith a'r ddylch yn ddod, drwy'r hyn o'r ddweud o'r ffordd yn y gyfnodau i'w ddweud o'r ddylen, mae'n oedden nhw'n ddweud o'r ddylch, media, ond ddim yn fawr i'r ffotographu, ac rwy'n gweithio'r prywodau. Y ddyn nhw ymlaen i'r ysgolfaeth i'r ddweud, ddyn nhw'n ddweud o'r gwaith o'r prywodau i'r llyfrfyniadau legislatifol ac o'r prywodau i'r ddyn nhw i'r ddweud o'r prywodau i'r ddweud o'r prywodau i'r ddweud o'r prywodau i'r prywodau i'r prywodau i'r ddweud. Arwai, rydw i'n ddigwydd. Rydw i'n ddigwydd ar y sefyllfa mewn agenda yw gwaith o'r ffordd o obisity. Rydw i'n gwybod i'n gweithio i ddim yn ystod i gael i'n gweithio i'ch byw yn y cymdeithasol i'r cyflwyth. Ond, nil Finlay, rwy'n ddweud yn y Llyfrgell wedi'i gael i'r Llyfrgell, i ag i'r gallwn Ieithaith Ffyrdd, ac i'r gael i'r ddweud i fynd i gael i'r ddisgu. Lleadyn Tulloch yn yr ydych ymlaen â farmershotau yng Nghymru. I'm Clare Hawke, deputy convener of the committee and the MSP for Rutherglen. I'm Tom Arthur, MSP for Runfordshire South. I'm Nanette Neutrie, professor of physical activity for health at the University of Edinburgh and I lead our research centre. I'm Miles Briggs, conserved MSP for Lothian region. Ian Finlay, chief officer of paths for all. Clare Hyslop, organisational leader for Dine and BC prevention at NHS Health Scotland. Good morning. My name is Alex Cole-Hamilton. I am the Liberal Democrat MSP for Edinburgh Weston and my party's health spokesperson. Alison Johnston, MSP for Lothian. I'm Linda Bald, chair in behavioural research for cancer prevention at Cancer Research UK and the University of Stirling. Rwy'r trelyw o MSP for Aniston and Belsam. Good morning. I'm Celia Neesons from Nair Scotland. Mwrni'n myriadodd, Highlands and Islands MSP. Good morning. My name is Joyce Thomson. I'm here on behalf of the British Dietetic Association. I'm Colin Smyth, MSP for South Scotland. Good morning. I'm Drew Walker. I'm the director of public health in NHS Tayside here representing Scottish directors of public health. Ivan McKee, MSP for Glasgow Proven. Thank you all very much for that. Donald Cameron will likely be late. I think his plane is stuck on the tarmac at Stonaway or something like that, so hopefully it will join us in a wee while. Okay, we're just going to begin. Alison, would you like to begin? Yes, thank you convener. I would like to ask those experts who have joined us this morning why it is the case that Scotland has the worst weight outcomes of all the UK nations and amongst the worst of any OECD nation. Given the potential that action in this agenda has to transform life for the better and save the NHS, a great deal of resource, why is this not a national priority? Thank you. Okay, who would like to begin? Linda? I think we've seen some fundamental changes in our environment in recent decades. The Scottish Parliament has been very courageous on tobacco and alcohol and the changes that we've seen particularly in smoking didn't happen because people decided not to smoke. They happened because we changed the environment and the opportunities that people had to make healthier choices. I think what we've seen in Scotland in recent decades is that we have very available, very cheap foods that are high in salt and sugar and fat that people find they can afford and we don't have the diet that we should for our children. In addition, obviously we have not seen an increase in physical activity and we don't have an active society. Cancer Research UK is hugely concerned about this. I think it is probably our biggest future public health challenge. It's the biggest preventable cause of cancer after smoking. For people who don't smoke, it is the single biggest preventable cause. I do think it's a public health crisis and unless we take action, our modelling shows that we will have almost 700,000 additional cases of preventable cancers in the UK over the next 20 years. You said that it was a future challenge, not a present challenge. I think what I would like to argue, and I'm sure my colleagues in the room would agree, is that we need a comprehensive strategy. That's a long-term strategy. I don't think that you can change this overnight. It's a current challenge now, but I hope that the actions you're considering will take us forward for many years so that the children who are starting school now will not have the potentially the same burden of obesity as those that have come in the last 10 or 20 years. I would echo what Linda has said. We know that Scotland has some of the worst statistics, but we're not alone in the world in facing this challenge. There are a lot of other countries facing the challenge as well, so it's not just unique to us. We know from the evidence that Food Standards Scotland have published evidence over the last few years that our poor diet has been ingrained. It's 15 years of missing dietary goals. It's been over decades that this has been happening. It's about the same thing that Linda was outlining, the environment around the diet and the physical activity that people are taking. That has the physical activity levels and a poor diet. Are there causes for that? Again, we have policies on this, but we need to move further with the fiscal and regulatory measures. There's been action that has been taken over a number of years, but we feel obesity action Scotland certainly firmly believes that now is the time for more of the fiscal and regulatory measures that are needed to tackle the poor diet that Scotland faces, and we need to take action to change the food environment. The health choice is the easiest choice for the consumer, and we need action at retail and out-of-home sector level to see that change. One of the reasons for the statistics that you mentioned is that 40 per cent of adults do not meet the physical activity guidelines in Scotland, and we believe that physical activity has a very important role to play in helping to prevent obesity, as well as a complementary role in addressing it. We've done extremely well over the last 50, 60 years in designing physical activity out of our lifestyles and having much more sedentary lifestyles. We need to look at mechanisms for trying to incorporate physical activity more into our everyday lives, whether that be for leisure or for everyday short journeys. As to why it's not a priority, that's a mystery to me as well, because it represents such fantastic value for money, and when we are really talking about prevention here, I'm curing the cause rather than treating the symptoms and spending a little now on physical activity and tackling obesity will save the nation a lot of money. A recent report by NHS Health Scotland calculated that physical inactivity costs to Scottish health service £94 million per annum, so by increasing physical activity we could significantly reduce this. The solutions here are very good value for money and quite easy, and why it isn't a priority is a very good question. I just wanted to pick up on what Lorraine was saying about the healthy choice being the easy choice. At the moment, the unhealthy choice is the easy choice. There's a bit of jargon we use when we talk about an obesity-genic environment where it makes it very easy to over-consume calories and to take too little physical exercise. We need to turn that on its head. We need to make it much more difficult to consume or much less attractive to be able to consume too many calories and much easier for people to be more active more often. Scotland's record in this area is worse than comparable UK nations. Is our environment particularly obesity-genic because the report last week suggested that we had a pretty good environment for physical activity yet we're still not engaging? Is this proliferation of easily accessible junk food? Is there more of it here? 40 per cent of foods in the UK are bought on promotion, and that is the highest rate of any nation in Europe. If we start with the sales environment, there are very clear indicators that some of the options that people have available to them are driving them in the wrong direction. That's just one example, but there are probably specific other examples where Scotland, because of some of the drivers, is worse than other European nations. I agree very much with Lauren and Drew said. I think the reason why in Scotland the issue is so bad is because of a combination of three very important factors, one being inequalities and a quite high level of poverty in the UK as a whole, but also in Scotland. It is proven that people on low incomes and with very small budgets for food will prioritise calories over nutrients, and the excessive amount of calories that we eat is what is making us fat. That's one reason, and obesity is a social issue, so we need to look at it as this. Another reason I think is the food culture, which Scotland is not famous for its food culture, and so the lack of skills, the lack of time dedicated to eating and the lack of habit to cook a good meal with a lot of vegetables, like the Mediterranean diets. The very important factor is adding to these two factors is the food environment that is extremely obesogenic, and we haven't so far taken a comprehensive approach to change the environment. It is still extremely difficult, even for people who have higher incomes to eat healthily, so this is what we need to look at. I would just like to follow up my colleagues' comments about physical activity and its importance. I think that I sit in the national strategic group for sport and physical activity, and I think that Scotland has admirable strategy in physical activity, and it has a very nice outcomes framework which is now monitored. What we're failing to do is implement that at scale and with resources. We have a number of small projects, but they don't appear across the whole country. We have a great set of plans, but no resources to push them forward to change the environment or encourage the one-fifth of people who are doing less than 30 minutes a week, and that's where we could do with improvement. That will undoubtedly help the obesity programming and agenda that we have. Emory? I'm interested in the international comparison, so I understand that we have an obesity-genic environment here in Scotland and possibly in the whole of the UK, and I hear that we have this 40 per cent of our food is bought on promotions. Why is that? Is that because we're less regulated than other countries or do we just love a bargain? That is because of our retail environment and some of the competition that you have between retailers, but also adding to the points that you made about some of the traditional choices that we've made in Scotland around confectionary and some of the things that people perhaps prefer to eat. If those are available, and we have children consuming them from very early in life and even pregnant women who have diets that are high in salt, sugar and fat, then those things come together. You have people's choices or preferences, which are established very early, and then you have an environment where because of a commercial environment, retailers are driven to sell things very cheaply. The price, I always talk about the four P's, price, promotion, place and the product, and the price is something that we can take action on as a single measure. I'm keen to pursue a point raised by Celia and that's around the issue of inequality, obviously the link between obesity and deprivation is well documented, particularly among women and children, and I'm keen to get the panel's views on why that's the case, to what extent existing strategies sufficiently deal with that particular issue, and what would you see as needed in any future strategy to tackle that particular problem? I can't speak about the physical or the medical reasons for that, but I think in terms of children, one reason could be that marketing is extremely aggressive and schools are surrounded by convenience food outlets and it is extremely difficult for children to ignore all that marketing and that convenience food that is readily available to them. School meals, of course, have also a role to play in this and free school meals have been very beneficial in helping children to eat healthily, so having school meals across the board and also looking at what children can eat outside school time is very important. At the beginning, I think it was yourself, Linda, who said that this was a crisis. Is there any of the panel who think that it is not a crisis? Is there any obesity sceptics in the room? No. It's very difficult, even in the media, to find people who are... You would always normally get someone who would argue the contrary line. I've never heard one yet. It seems to be in a crisis and that requires a very fundamental response to that. When we look at some of the commentary on the obesity roadmap, it says that the number of interventions aimed at attitudes, values and behaviours outweighed those aimed at costs and regulation. That was at odds with the balance of international evidence on what would be the most effective for obesity prevention. Is that a general view that we're actually going down the wrong route on this? I just wanted to respond to Colin's question about policies. I'll do that first if you want. If I could just reflect on where obesity is, is it a crisis? Yes, it is a crisis, but it's been a slow-burning crisis. If we had been sitting here 10 years ago, I think that it would have been quite difficult to have got support for saying that we were in the middle of an obesity crisis, because people hadn't woken up to the problem that we've got. Joyce Thompson and I published in Tayside our healthy weight strategy 11 years ago, and I was criticised by my board for wasting my time and the time of my colleagues and partners on something which was nothing to do with public health. It's inconceivable that that comment would be made now, because in the intervening years we have woken up to the crisis of obesity and of the threats to everything that's important to us. Things have moved on, and in relation to policies, to pick up on a point that others have made already, we have fantastic policies in Scotland. If we were to implement policies that we've got, we would be a long way down the road of tackling the misogenic environment and all the things that are pushing us in the wrong direction. The issue is not shortage of policies. The shortfall is in the implementation of the policies that we already aware of. That's not pointing the finger to anybody in particular. That's all of us. Well, I think others might want to come in on this, but we have the route map. It's got a whole range of things that need to be done. Some things have been done, but a point that's being made, things not being done at scale. There are lots of good initiatives being taken all across Scotland, but the successful things are not necessarily being scaled up. They're not necessarily being adopted with the level of investment required right across the country. There's lots and lots of examples of that, but other colleagues might want to give more detailed examples of that. What I would say is, and that's responding to a few of the things that have been raised, the review that looked at the beastier route map, and that was a statement that was in our evidence that we submitted the statement that you read out, convener. The number of interventions did look at attitudes, values and behaviours. What I think we've found is similar to what Drew said, as the awareness of this issue has grown substantially over the last decade. I think that has probably partly had an input to the inequalities changes that we've seen, because we know that the least deprived people will respond to those messages. They'll respond to the health messages that they hear and they'll do something about it, so that may have been something that we need to think about other ways of addressing it to make it fair across the board and to help the most deprived people in society. I wanted to highlight that. That's one of the reasons why we need to move much more towards these interventions around cost and regulation. As Drew said 10 years ago, they would probably have been fairly difficult to take forward because there wouldn't have been the level of support and the level of acknowledgement of the issue, but we're now at a stage of recognition of the problem. The original obesity route map did recognise that we need to change the food environment. It's not new, but we went through a process of voluntary approaches to working with the industry over the years, but we now know that we haven't progressed as far as we need to progress with those voluntary approaches and we now need to think about regulation being introduced to tackle it. I would be interested to hear what the panel's thoughts are on regulation and what regulation they think would help to tie in with some of the obesity strategies and help to reduce overall weight. Can I just go back to the four P's of price, promotion, place and the product? Ideally we need to change all of those and those are things that we can change. Some people have talked about promotion and you asked the question, convener, about does anybody disagree with the need for action on obesity? I think the problem with promotion so advertising of foods that are unhealthy is that if people have these other initiatives where their attitudes and behaviours have changed and they're trying to make healthy choices they're actually pushing against basically what is a tsunami of advertising because you're surrounded by on television, billboards, etc promotion of very cheap foods and we did some research through Council Research UK with children where they talked about how they felt when they saw those ads and one of them said they wanted to lick the screen on a TV screen. It's really compelling and it's difficult to push against that so that's promotion. We've talked about price which is the other driver the product also reformulation is something we might want to talk about I knew Food Standards Scotland have talked about lowering the salt and sugar in particular products but crucially place as well so when we look at where products are promoted for example we know that some junk food that's on the rotunda displays at the end of the supermarket that can increase sales by up to 50% so those are things around the environment those are all regulatory changes and just finally on public support we know that about almost 80% of the Scottish population agree with action on junk food advertising and just slightly less on price promotions so the public are in favour industry won't necessarily like this they are likely a different voice but I think things have changed but those are some of the mechanisms I think we need to focus on Clareynau I think what we need to do is we also need to recognise some of the actual really successful policies we have had in Scotland over the last few years and certainly we've done a lot of individual work around schools and we're doing work in hospitals various other different areas but I think what certainly from our perspective what we realise is we've not all come together and these things quite often have to be choices that people have to make so that individual behaviour changes and we need to start to look how we can actually affect the population rather than relying on interventions which make people have to actually choose to take these up and that's why some of the measures that other people have been suggesting today will be more successful for making change wider and I think as well in terms of inequalities that also makes we're less likely to widen any gaps if we do things on a more population wide basis and I think that's in the past maybe where the gaps widen slightly around DPC is because we've done interventions which are only chose by those who can make that choice so things like leaflets for example are only going to be read by people who are interested so I think we need to look at when we're addressing this new strategy is making sure that it's holistic and we're taking all the different approaches including environment and not just relying on people's intervention basis Ian You asked for some specific examples I could give you two the physical activity strategy has now been in place for over 20 years it's internationally renowned as a good strategy a lot of very good intervention has taken place within that strategy I mean such as the work that PAS for all does in the walking schemes and we're seeing some hopeful signs that the Scottish household survey showed in walking but I would agree very much with what Professor Mutry is saying that these need to be scaled up the sorts of interventions and if they were scaled up to a bigger level I think we would see more progress so that is about long term sustained funding leadership at all levels so that's one example of where we've got a really good strategy in place but implementation needs to catch up the other is the national transport strategy the national transport strategy has a hierarchy where it puts walking and cycling at the top followed by public transport and then the private motor car however as we all know probably reality is more real in terms of priorities and funding recently Transport Scotland undertook a study into how to increase physical activity and how to best implement the physical activity policies we have the act of travel policies that there are and that came out with the same sort of conclusions that's about long term sustained funding so there's two examples where we have very good policies in place but what we need to do is make sure that the implementation of these policies catch up and I think we're starting down that journey I think there's a lot of hopeful signs but that implementation needs to be accelerated to see the population scale change it seems to be very good at writing strategies but not very good at implementing and is that what you're saying? This is tongue-in-cheek but a number of our partners hold an act of travel conference each year and three years ago we asked a policy guru from Europe to come across to have a look at Scotland look at our policies and how we're implementing walking and cycling for everyday search journeys and the person came across for a week and his conclusion to the conference was you must have a policy because his conclusion was that the policy framework is actually very good and really what we need to now focus on in Scotland is implementing those policies and make sure that the leadership and the resources are there to bring that about Nani? Two points, one about inequalities and one about potential regulation and I think for physical activity inequalities is different than from food consumption and the mode of activity that people are doing or critical sport has a lot of inequality but act of travel does not and we've just analysed the act of travel data this is a good news story for Scotland it is increasing in urban and rural for both men and women and across all social classes and yet it's not part of our outcomes framework we're not monitoring adult act of travel so I think what Ian said and what I'm saying is that that needs to be done in our implementation the biggest inequalities for physical activity are age and our older population potentially could benefit most but are doing a miniscule amount of activity in comparison to our younger generation and gender universally and Scotland is no different men are more active than women and that's an inequality we should try to close in terms of regulation I think there are tough choices we might not find a regulatory mechanism to increase activity but it might be around act of travel and these are tough political decisions such as restricting car access to town centres, pedestrianisation increasing car parking charges difficult political and unpopular decisions to make but these sort of things we've seen from our European counterparts where cycling is so much the norm that car usage is going down in Denmark for example and these are decisions that will help to create a more active environment a less obesogenic environment Ivan There was a couple of things I wanted to just explore around about some data points of thumb tempted to come back and talk about the issues that you've just raised there in respect to the planning system because I think there's an issue there I might be going to that if I've got time on trends in terms of where we are and if you look at the data that's there and the health survey you can see in terms of obesity you see an overweight statistics you see a rise through the 90s in the early part of the 2000s and then for the last number of years it seems to kind of flatten off so I suppose it was just to explore that is that the reality or is that a consequence of policy changes or is that just a natural phenomena that will rise at that rate forever and the second issue I wanted to maybe try and explore around about the cost implications of that I know there's been one or two numbers put out this morning I know you were also talking about the impact on cancer so I'd really like to understand the implication of that now and in the future in a kind of macro sense because if you look at the health service in Scotland, it spends about 13 billion and if we continue doing what we're doing increasing obesity have on those kind of numbers at that kind of big scale and I'm assuming somebody's done the analysis between your typical average weight person how much they cost the health service and your typical obese person how much they cost the health service over a period of time to factor that out so I don't know if anybody's got any kind of comments in those areas I'm sure other colleagues can talk about other conditions I mentioned the modelling we've done around almost 700,000 additional cancer cases and we had a 1% reduction in obesity each year in the UK there would be about 40,000 fewer cases of cancer each year and we know that would probably save around 40 million to the NHS so there is modelling that has been done around that across the UK so you can divide that by a factor so those modelling figures have done for the UK so we are very clear on the cost savings we could take just on your first question about the trends I don't think we should be complacent it's encouraging I mean there are issues with the data particularly some of the issues around underreporting in some of the surveys where we see in terms of calorie consumption there's clearly underreporting then when we look at sales we see there's a big gap so people are not necessarily feeling comfortable about reporting what they consume but I think we still have record levels so even though we've seen a slight levelling off which is particularly positive in some groups I think we need to recognise that those are still historically high levels compared to other countries and we know what the cost implications are I suppose the question is that a result of policy or is that a natural phenomena because if it's a result of policy then clearly we've started to do something I thought Ian and the Nets comments were very helpful around some of the fact that we have had these strategies and there have been some very positive examples but it's not on the scale that we need to see it I think that's the take home message the plateauing of the data just to expand a little bit of what Linda is saying it's easy to get misled by that plateauing it looks like it's good news that the increases we were seeing some time ago have plateaued out but that's if you look at the whole population as an average if you break that down into socioeconomic groupings you see a different story what you see is that the level of overweight and obesity in more affluent populations has fallen slightly over the last number of years conversely the number of people who are overweight and obese in our poorer populations and this is adults and children has actually increased slightly so any complacency that should wipe that away straight away because we know that that is a significant contributor to the widening health inequalities that we see around us so let's not be fooled by the average we need to look at within that average and what it's telling us about different groups Joyce I would just certainly echo that was the point that I wanted to make as well and also to highlight in terms of the surveillance data that we have we have the child health surveillance programme so at school entry so we have data on BMI and children and thereafter we've got the Scottish health survey it would be very very helpful if we had more consistent surveillance for example at secondary school entry as well so I think we're limited from that perspective as I say Drew I think you're absolutely right in terms of the difference in inequalities which is particularly specific to children and women but I wonder if I could also just add into that and I completely agree with all of the comments made by colleagues and it's highlighting one, this is a complex issue and two, we are talking about physical activity sedentary behaviour and diet but we frequently talk about it in this country without actually necessarily associating it with the situation of obesity and this is particularly true for children but also adults as well in that we don't recognise ourselves as being overweight or obese and that tells me two things one, most definitely we need to address the prevention side which includes legislation but we can't ignore the fact that a significant proportion of our population already suffer from the condition therefore we need to support these individuals as well On that the point of monitoring weight through the child's school career because have they agreed that we should be doing that more? In England there is that routine weighing at that point as well and I think that's the point you're making about secondary school entry so fantastic that we're doing it when children start school but let's do it a little bit further up the educational pathway as well so we've got more data points and we can be more confident about the monitoring Okay Celia Just go back on the question of regulation I think one of the reasons why we haven't really made much progress so far is that we've been looking in silos and looking specifically at changing people's behaviours without changing the wider environment and I think a framework that could be used to guide policy on this and that is being used already by the Scottish Government on climate change is the ISM framework I don't know if people here are familiar with this framework but it's an individual social material framework that sees that individuals are part of a social context which itself is part of the material context and you cannot change individual's behaviour without changing the bigger context in which they are integrated and I think looking at obesity with this lens would really help regulation and policy actions Okay Marie You wanted to make a... that you raised before the meeting Food promotions I think Oh yeah, the food promotions I am struggling to understand why our commercial environment is so significantly different from the rest of Europe so I understand that it is much more competitive but is there more regulation in other parts of the world or what is it that makes it so attractive for UK and European promotion? Do you want to comment on that, Lorraine? Some of the analysis that's been done Yeah, it's something that's still being looked at and we're still trying to get a good international feel for it I think it's less about the level of regulation and more about culture and the food culture that exists in other countries around how they eat and what they eat so we are looking as far as we can for examples around the world and we're seeing some countries that are bringing in other regulatory measures and you all know the examples from Mexico about the sugar tax and Chile about advertising but in terms of other European countries it seems to be more of a cultural issue than regulation MD, what's on that issue? There's a little bit more information about the Mexican sugar tax because would anybody else be interested in that? We didn't get that in the submission Lorraine and I agree on almost all of this there are some good examples from other countries to the nourishing framework which has been established by the World Cancer Research Fund where they have a database that looks at what all countries are doing on food promotions and other food action on healthy diets and there's some useful comparators there but just on Mexico so they introduced a 10% levy tax on sugary drinks which resulted in a 10% consumption over the period they were monitoring it interestingly as well the intention of the revenue from the tax was to look into public health particularly providing cleaner water and schools and other measures that communities could use so that's a really good there has been criticism from commercial partners of that policy and the interpretation of the data and this always happens in all areas of public health but we can be relatively confident about the Mexican data that they have seen that 10% reduction they had some of the highest levels of carbonated sugary drink consumption at very high levels here as well so it's an interesting example Just to add to that the Mexico is a good example and we've seen the consumption go down and we've seen that sustained there's now some evidence from the year 2 of the tax and it's sustained the fall in consumption and the interesting aspect that Linda highlighted was the reinvestment and provision of water which was a popular part of that tax Alex I'm really struck by the four Ps that we've heard about today and I'd like to focus on two of them related to this discussion that we've just had on promotion as well but first in terms of place I think that we've discussed availability and access to healthier options and I reflect on the fact that I did some youth work in some deprived areas of Glasgow and we were talking about nutritional eating with the young people we were working with and then it was falling on deaf ears because actually there wasn't actually stocked any of the healthy ingredients that we were talking about but it's on the promotion and particularly targeting of advertising at children that I'd like to get the panel's reflections on often struck as a parent trying to buy healthily from my kids but find myself being duped into buying things which have no added sugar but then you see the sugar content and it's astronomical or the things which talk about calories which vary calorie per 100 grams or per half portion or whatever and that you actually have to really interrogate the back of the label to work out how many calories you're giving your kids because that changes from product to product and also those products which talk about being one of your five a day which I've absolutely took as gospel until I saw a programme to say that actually there's a lot of producers kind of nefariously swinging the lead on that and just wonder if you can talk specifically about the impact of advertising on children and how we better educate parents to buy better for their kids thanks I don't want to dominate at all but if I just give you the example of one experiment that was done in Liverpool so these were kids who were invited in and they were shown TV ads and some of them were shown adverts for toys and the others were shown adverts for junk food and then after that they were allowed to go and have lunch in a room with a buffet and it was monitored how much they ate and the children who'd been exposed to the junk food adverts ate significantly more at that lunchtime than those who'd seen the toy adverts and those levels of consumption were higher in the kids who were already overweight or obese so that's just one example of promotion I think what Cancer Research UK specifically calling for is that the Scottish Government would strongly push and encourage the UK Government to introduce the pre-watershed ban on junk food advertising on TV because even though people often say oh well it's all about digital media nowadays kids are looking at small screens and TV advertising is still a major driver of consumption but within Scotland there are other things we could do in the retail environment on promotions some of the devolved powers we have around advertising and I think we should look very carefully at that and there should be an analysis of where action could be taken that's within the powers that we have here Lorraine? Just to add to that there's a lot of really great evidence coming from the cancer research UK about how children respond to adverts and we would support a call for the 9pm watershed on TV advertising but as Linda said there are other devolved aspects to advertising that we would ask the Scottish Government to look at in terms of billboards and bus stop advertising and things that there are some controls that could be implemented within Scotland that could have an impact on the type of advertising that's seen by children in terms of race around labelling again it's something that we're very interested in there's a very complex mix of where the legislation sits for labelling and a lot of it is at European level just now so the timing is probably it might be that once we're a bit clearer on where we're going with European aspects we could look again at labelling and what that could offer us in terms of improving how people understand and part of that labelling is also around understanding portion size because there's a lot of confusion with the public just now around what the label tells you about how much you should eat and the portions that are available Ian Can I pick up on the question regarding data and particular look at costs and money because I think the important point I'd like to make here is that a lot of the interventions we're talking about here although they cost money are a net saving we are very much looking at preventative spend here spending a little now to save money I've already mentioned the finger of £94 million per annum and the cost to the health service of physical inactivity but there's been quite a bit of work done on cost-benefit ratios and social return on investment studies looking at cost-benefit ratios like Dr Adrian Davis has done work on active travel cost-benefit ratios and looked at the cost of walking cycling infrastructure and he's come up with cost-benefit ratios about one to 19 so for every £1 spent on active travel you're getting about £19 of benefit he compared that with road infrastructure and I'm not against roads and cars they are important but if you compare that with road infrastructure if a road's development gets a one to two cost-benefit ratio then it's considered to be a really good piece of road infrastructure on social return investment I'm aware of four independently verified studies on walking and cycling infrastructure and all of them show a ratio of about one to eight either one to eight or one to nine for those four studies so every £1 spent delivers eight or nine pounds of benefit and the top benefits and all of those four are health benefits so it's physical activity tackling obesity and the likes so there is some hard data out there to show that these sorts of interventions work they are good value for money and taken over long term are actually a net saving to the nation The strategic plan for this committee highlights preventative spend health inequality and cost effectiveness has been our priorities and all of that would seem to hit very squarely with this issue but my issue is that a number of the things that people have mentioned around the table like sport particularly local sport or activity local travel active travel things like older people's clubs walking groups all of these are funded by local authorities or were in the past and if we are to address this how on earth can we address this in a preventative way tackling health inequality local government is going under the pressure that it is financially at the moment is it possible with the current policy agenda in terms of the finances of the local government that we can address this The public sector more widely needs to play playing as full a role as it can the very least we should expect is that the public sector doesn't add the existing problem and I wonder whether that is the situation at the moment if we think about the hospitals within the NHS for example we shouldn't be expecting people who are attending health facilities to be experiencing an obesity environment but that's exactly what they do experience in far too many hospitals in Scotland so the first thing that you do when you go through the main door is you come across a commercial outlet which is marketing very heavily energy dense food when you go into staff canteens the choices the food choices are too often again high calorie low nutritional value food I don't want to say too much about the local authority because I don't have so much knowledge about that but at least within the NHS we should be expecting the NHS to play a full role in not at least promoting obesity in the way that it currently does See we are On the point of cost effectiveness well regulation is quite cheap I guess it needs to be done well and on that issue I think it's really important that policy makers take a very comprehensive approach when looking at different aspects and for example when looking at advertising a ban on TV advertising would be very positive but it will just mean that resources will be channeled towards other channels of advertising and for example digital advertising is a huge issue the WHO published a report quite recently on digital advertising to children and it's quite scary through social media or pop-up ads on games that children play on their phone tablet advertising is everywhere and that's really something that I think regulators need to look at and I've got another point on the sugar tax as well Norrish supports sugar tax in principle but we are not entirely positive about it because on one hand it tends to affect poorer families heavier and on the other hand because if you tax sugar in some drinks people will just choose other drinks that are cheaper also drinks with aspartame and other fake sugars are not much healthier than drinks with free sugar so we we're talking about another sort of tax that is a far way ahead but we think it would be much more effective and we call it a multiple retailers and caterers levy and this would apply to multiple retailers and caterers like Tesco, Asda Greggs, McDonald's etc and it would tax the health difference between what they sell and what they should be selling us to feed us effectively because we've got those dietary goals set by the Food Standards Scotland and we're not meeting them but we can't meet them when everything that's in the shop is not compatible with those standards so if supermarkets and other caterers and retailers had to report periodically on their sales they know the content of their sales and know how many calories how much free sugar etc and then pay the difference that amount and the amount that they would have sold if they sold us healthy diets it could be positive if they sold more fruit and veg than we need to eat then this will become a subsidy but we're quite far away from there but at present for example supermarkets sell about 30% of free sugars as a proportion of dietary energy whereas the recommendation is that we eat only 5% of free sugar and the difference within a levy would be applied to this difference and that would really incentivise supermarkets and other caterers and retailers to look at how they market their food look at reformulation what are they selling us so that they'll have to pay less of that tax and we think that would be a really more comprehensive approach and then the money from this measure could be used to fund fruit and veg vouchers or the healthy start campaign or the such public health measures Yes, thank you I probably would like to follow on from Celia's points there it seems to me that we have two food cultures in Scotland because we export some very high quality food seafood and meats and so on that many people in Scotland can't afford and never eat because of our food culture don't understand how we might best prepare it and so on and so forth I think that most adults I think that three quarters of adults believe that their diet is healthy but if two thirds of us are overweight then there's clearly a misunderstanding there and I get the impression from the evidence too that there's an understanding that reliance on individual behaviour change here won't suffice that we need this societal shift The Green Party manifesto did propose a levy on retailers and caterers and I'd be interested to hear from the panel their views on that I understand that the sugar tax has success but I do believe too that there are concerns about a potentially regressive nature and the impact on those on lower income so I suppose it's about the fact that private companies are benefiting from the sale of this very unhealthy potentially addictive food but the public purse is picking up the health bill at the end of the day and also impacting on people's quality of life the other thing that I think we could be doing look at our high streets I think we do need to be discussing where we're buying our food and what we're buying because there has been an impact on the number of small independent retailers where you can go get great advice buy that fresh food and understand what to do with it so I'd just like to understand from experts what they think about the impact supermarkets have had on this agenda we've been doing quite a lot of work in Scotland looking at retail outlets and we have obviously supporting healthy choices which is our voluntary framework and we've been doing things on a smaller scale through the Scottish Grocer's Federation healthy living programme where we're actually going to retailers and encourage them to provide fruit we do work in hospital settings so recently we've just introduced that all hospital retailers are actually having 50% of their food on offer will be healthier options but again it's about setting that example and we're not doing this across the board so we need to look how we can scale these things up to actually have much more an impact more broadly on the population and I think that's where working with bigger retailers on price promotion, positioning even where the products are positioned how they advertise if they're using different mediums to attract a certain audience and actually look in how we can change that balance and that's what we need to do now to move it up to the next step so we have got success well I think there's now over half the convenient retailers in Scotland or within the healthy living programme but we're still not seeing changes to the basic level so we need to take it to the next level and making it much more across the board to have an impact or come back to you after we do this route I think it's just important to remember that there is no single intervention that is going to solve the obesity crisis that we face it's going to take a whole package of measures the McKinsey Institute did a report quite recently and looked at a whole broad range of interventions and nearly all of them were labelled as cost effective in terms of making a difference and I think that's something we need to come back to so there are individual things we can talk about the sugar tax, retailers levy, there's all sorts of individual examples and we need to look at the evidence behind all those individual examples but we need a whole package of them and the public health England evidence that came out recently did a very thorough review of the evidence around what ones would be most effective and they put up their price promotions and advertising and marketing so we really need to look at them and think about that evidence that already is out there a whole package of things Thank you, I just want to go back to what Mr Cole Hamilton raised in terms of some of the complexities and confusions around being able to select the right products for children etc I think what that reminds me to say is just to recognise the fact that there's significant issues with regards to health literacy in this country that we need to take cognisance of so even though we produce the best materials it's quite difficult for a significant chunk of the population to utilise them so we need to think about that added to that though undoubtedly under the guidance of the Scottish Government we do have for example the maternal and infant nutrition framework we've got various policy in relation to education and granted I work in a very practical arena and therefore recognise how those have been very helpful in helping us to help the different populations in terms of some of the practical support that's needed in order to make those choices and from the perspective of some of the information that comes through from a nutrition and dietary perspective it is important clearly that the key messages are current and correct and also consistent if the knowledge and understanding about food and nutrition across the piece doesn't reflect that that's when it can cause lots of mixed messages the second point I just want to go back to convenient you made some reference to the financial situation that we're in particularly with regards to local authority and some of the decisions that they're having to make and again what that in my head points us towards is what else perhaps is possible out in our communities so for example we have worked under way locally where we are working with two parts of the community within Dundee in order to co-produce some preventative actions around the obesity agenda undoubtedly I'm representing the British Dietetic Association dieticians most definitely are registered personnel with a nutrition background and many are considered experts in the field of obesity prevention and treatment but we also recognise that some of these interventions are perfectly possibly able to be delivered by volunteers or other individuals within the community with our guidance so I think that perhaps provides us with opportunity which is yet to be realised and whereby we're actually utilising or working with the community as opposed to doing things for them It's fair enough but if at the same time active travel's reducing if the same time as fresh food and veg co-ops are closing and all of that goes on then we are really we're scratching at a very tiny part of that not that we shouldn't do it but to put that into perspective in the bigger picture I think is very concerning when we see all the rest of what's going on Linda then Alex I just want to make one point about cost effectiveness something we haven't touched on which I hope the committee will note and I know it's in some of our statements is around the importance of primary care so I think you made a very good point around interventions that can happen in the community In Scotland we've had an ABI programme around alcohol delivered by GPs and others which has had some success we now have a very good randomised control trial that shows the benefits of brief advice for weight loss delivered by GPs where people who were randomised to receive the intervention lost double the weight of those in the control group and we've done that for smoking we know we can do it for alcohol but we are nowhere near doing it for weight in primary care and that's something that we can do in Scotland so that's just another suggestion Alex I thank Joyce for picking up my point about awareness amongst parents as to what they should be buying for their kids and then the difficulty they face when they go into the supermarket with that which I'm going to call us paid as paid here and the duplicity and nefarious tactics of producers in trying to get round that awareness and I think that actually I would argue that as a country getting our parents as to what healthy food looks like the information is there and available if you want it obviously getting people to access that is different but if you go into a supermarket and reflecting on this I bought a bag of toffee popcorn the other day because it said on it that a portion was only 112 calories I thought bonus but that was for a 25 gram portion if you look at what a 25 gram portion of toffee popcorn looks like is utterly heartbreaking that's not a snack that's not a treat and then actually to get you a fill you have to absorb another 400 calories worth of it but that's the thing I think that we have to box clever with the producers they have a responsibility when I went into Sainsbury's to buy a banana and the frequent item section only had cakes buns and chocolate confectionary on it and I tweeted them and I said maybe it would be cool to start a trend here Sainsbury's but I wonder if you could give us a bit more reflection on what we as politicians can do to stamp that out I think that's a good question and I don't think there's any one particular solution to that I mean you talk about Sainsbury's test goes on the other hand giving away free fruit as soon as you go into the store for children which is actually a very positive move so yes I think that's a very difficult one regulation though retailers will respond so if things like price promotions and other marketing there's restrictions on that or we try to modify some of what they can do we've already seen this with some of the debates around the sugar tax and changes that producers are making they then think of alternatives which might be sometimes a healthier alternative because the retail sector can be a very important partner Ian I pick up on the point regarding the challenge of local authority capacity and just agree very much with that if we are accepting that policy implementation is a priority rather than new policies then the fact that there is reducing capacity and skills within local authorities I think is a huge challenge path for all the number of our partners like Sustran Cycle and Scotland Living Street Scotland most of our work is delivered through local authorities and so in a climate of reduced skills and capacity within local authorities that is a big risk to the interventions that we are hoping to deliver so I just reckon that that is a very important point as to the solutions to that that's more difficult but I think it is about prioritisation I mean in any organisation with less resources you have to prioritise more and more and I think the challenge for all of us is to make sure that obesity physical activity is higher up the prioritisation list within local authorities than it is currently I think it's also the fact that the agenda we're talking about today is not yet a vote winner and that is very important at local authority level we're coming up to local authority elections in May and if what we're talking about here today does not feature of local councillors hoping to be re-elected then that is a bigger challenge so I think we need to make sure that it is a priority with elected members as well and set in budgets I mean going back to the act of travel conference that I mentioned we did have a panel of MSPs it wasn't local authority councillors last year's conference and one of the questions was asked does walking and cycling feature in your mailbag and it was all five main parties and all five said no yet it's not something that features strongly in the mailbag for ourselves so I think there's something around that the other point I would make is I think although it might be contrary to the concordat between national and local government ring fence funding can be very useful there is the cycling walking walking safer streets fund that is incredibly useful in this time of limited capacity within local authorities because that money has to be spent on walking and cycling so I think finding a way of ring fencing funds rather than ring fence funds is something that could help Ivan I just want to come back on some of the just to make a point really I don't need to respond on this specifically because the numbers that have come out and the number of 94 million was mentioned as a potential saving but if you look at it in the context I'm shocked at such a low number because that's 0.8% of the total NHS budget and even taking the 40 million number if you work that through and you assume nobody in Scotland was overweight that comes out at about 250 million savings in the Scottish context which again is less than 2% of the NHS spend and I'm struggling to make sense of that and it might be interesting for us to pick that up from a spice point of view later and just do some more digging on that because I would have thought the number would have been 10 times that but just for the record the thing I really want to just equation a kind of hint on it before was do you think there's stuff in the planning system that mitigates against active travel anecdotally to somebody very senior in a planning organisation and asked them why they were building housing estates with a couple of thousand houses with not even a corner shop in them and you said that's not a problem because if they need to buy anything they get in their car and they drive to ASDA and that was the response so do you think there is something in a planning system that causes problems there? I think the planning system has an awful lot to offer in terms of tackling what we're talking about I think we've done very well planning physical activity out of our lifestyles, out of our communities our planning system is and when you see communities being developed the motor car tends to dominate the way in which we plan our communities so I think the planning system and review the planning system is a huge opportunity to address that so that we make our communities more walkable more cyclable so that we tackle both physical activity and obesity it's also worth bearing in mind we did some work as an active travel alliance 50% of the population either doesn't have a driving licence or access to a car so looking at inequalities and health inequalities over half the population the private motor car is not an option so if we are planning the way we travel the way we design our communities around the motor car then we are instantly excluding about half the population so I think there's a big inequalities argument here but I think there's a huge... I wouldn't say so much that the planning system is a problem but I think the planning system is a big part of the solution and we've got the opportunity with the planning review coming up to make sure that's walkability and cyclability of our communities making sure that our services and people are is incorporated into the planning system Just to pick up on an Ivan's point about the cost of the NHS something that's entirely preventable that's costing the NHS hundreds of millions of pounds every year I think should be a priority for us and we've got to bear in mind that it's not just the NHS that bears the brunt of those costs of local authorities other public sector bodies that are negatively impacted as is the economy we know that productivity in our workforce decreases as obesity levels increase so there's triple quadruple whammies coming cost wise and I think it's also important to consider this whole discussion around obesity in that wider context there are other really important things about promoting healthier eating and higher levels of physical activity the impact of a change in the current situation might have on the Scottish food industry which are all entirely positive things the Scottish public transport sector can benefit from a change towards more active travel the impact on climate change which I think is a really important one the impact on pollution and we know that people's health is being negatively impacted on by the emissions of vehicles and so on the whole impact we know that health inequalities if we reduce health inequalities it's not just people who live in our more deprived areas who benefit the whole of our society benefits from having a smaller gap between the rich and poor so there's win-win winds all over the place not just in relation to obesity but in relation to our entire Scottish social and commercial economy From what we've heard this morning I think it sounds like you're in the agreeance that there is a lot of good policy there it's not just being implemented on the ground and so I specifically wanted to ask the panel around this cross portfolio approach because we found last week on the social health strategy almost education committee of this parliament should have been pursuing a similar inquiry as we are doing so to what extent do you think when policies produced it's then not being picked up by schools and not rolled out and I think that's where we all have really good examples of walking buses and the daily mile things like that in schools but it's very few schools who are actually delivering these so where do you think the problem is as a panel to actually making these policies be implemented I would start by saying from my experience it's actually lack of resource so we have a framework, a plan an implementation opportunity but no resource going behind that to move it out to local authorities or incentive indeed for local authorities to pick up what is good government policy and that is the gap that you've been talking about now it's not a huge resource I mean the spend to save that we've been talking about is a small resource to make that happen at scale at every point of delivery that we can imagine in Scotland A much sort of example then of not having that resource Well we have a framework that says we will try to decrease the number of inactive people in Scotland there it is that's what we have to do we've got some ideas of how to do it no money to spend on doing that or to receive the local authority to receive from government to do that Lorraine The cross portfolio part of it is very important and one of the things I would come back to as an opportunity at the moment is the work that's going on around good food nation if we want to promote ourselves as a good food nation and we have a good food bill coming out then we really need to think about to be a good food nation we really need to also be meeting and so there's lots of opportunities for cross portfolio work in this area and you're right we've already talked about things like healthcare settings and education and aspects like that I wanted to just come back to some of the other issues that have been raised earlier around costs of obesity and there is some information in some of the spice briefing that was issued a number of years ago around cost which we need to gather more data on to try and update then but it's looking like it costs between 60 million to 600 million to the NHS in Scotland annually to treat overweight obesity it's much more difficult to cost out because there are so many health implications of obesity it's a broad range it's not just cancer it's type 2 diabetes it's other complications in pregnancy it's a broad range of health impacts associated with it and that's why it's a much more difficult issue to cost up than some of the others we also know that there are some of the stats you'd asked earlier around costs of so we know that someone with a BMI of 40 probably costs twice as much to the NHS than somebody with a BMI of 20 so there's that kind of information that's already available around costs I agree what you said and I totally get that but I think we need to get that on the table because the flip of that question is if everybody in the country was fit and healthy why would the NHS still need to spend 98% of what it spends today and we need to see what's going on to follow this point for the 94 million that Ian quoted that's 18 pounds per person in Scotland for the cost of inactivity but these are 2011 figures and when Harry Burns was the chief medical officer he thought that was totally underestimated and one of the reasons is when you do these calculations you can't include many of the things that Lorraine has mentioned mental health for example wasn't included in that cost because the data are not available in the same way as other more standard things like cardiovascular disease so I think these are huge underestimates of the cost of inactivity from what Ian's point of view was am I allowed to just take another point I wanted to raise the issue of individual and societal change now I completely understand that we need a societal change but if we say it's not an individual mechanism we risk people not taking any action normative change happens when little groups of people start doing things differently and it becomes the norm and so we must continue I believe to promote things that are proven to be individually focused interventions providing they can be done at scale and then we begin to change the culture from those individual approaches and to take that point further politicians and leaders around the table are champions for such change now the Scottish Cancer Prevention Network has a lovely set of guidance about how to conduct a healthy meeting I would give you gold stars for water and fruit that I see over there but we've just ticked past the 60 minutes no meeting should continue for 60 minutes without an active break because sitting as we're doing now expend zero calories standing as you might do for five minutes doubles that calorie expenditure now you are smiling because that is so far from the reality of how we conduct meetings that is amusing to you but there is part of the problem and people need to take the active opportunities that they are given and we all managed against some resistance to walk up the stairs today but the elevator was the thing that we were shown you have a lovely building with lovely stairs and we must be the leaders of individual change in conducting healthy meetings and avoiding the totally sedentary society of the workplace that we've managed to create I'm glad you mentioned that there are so many ways in which in this place we do not practice what we preach we have a gym in here that's not got any equipment in it and has never had equipment in it and the reason is because politicians don't want to spend the money and take the criticism from the public my understanding but also in the way in which we conduct meetings they are absolutely right to me which we travel here some of us all of that we are very hypocritical and I absolutely accept that phonele remember never to use exercises punishment that's all drew I think the next actually picked up on the bus I agree with what Professor Mirtri just said but I do want to highlight that as long as the environment is against people having healthy diets and being active showcasing best practice and leading by example is not going to be scaled out and especially in lower socio-economics groups they're just not going to be able to change your behaviors because they're not in a position to do it what I really wanted to say is to come back on Mayn's break's point I think it's a really important issue how do we work together and make sure that the policies that we make are effective and are enforced and something that Nourish Scotland has been doing is trying to work with people with lived experience we do this in the field of food insecurity but I think in obesity and nutrition a huge potential here as well to talk with people who are struggling to change their diets and see what can help them change the way they eat and change their activity physical activity patterns and definitely the Good Food Nation Bill is also a huge opportunity for policy makers to work together with social justice departments with rural economy and connectivity with environment and with health to look at food with really a comprehensive approach and see how we can bring these different issues together and find a good framework that enables us to act at your time what I was going to do just finally is to ask each of you the participants just to give us a 10 seconds you ask of what we should be doing now here with the powers that we have what could we do 10 seconds or so each OK, we would ask you to support the need for regulation on issues like price promotions advertising and marketing and portion size across the retail and out-of-home sector I would ask you to implement our existing strategies at scale and with resource sustained long term investment Thank you We would want to look at a coordinated approach across portfolios to prevent obesity ensuring that we address inequalities and not widen the gap any further Wanda So I would just call for a comprehensive strategy that focuses on the individual and society I talked about the four P's those are very much population level interventions but we also need potentially primary care and other interventions to support individuals We would ask you to work really hard to make the good foundation bill a very ambitious piece of legislation that links food, farming and health and that uses the individual social material framework to look at all these different levels The BDA would ask you to lead an effective and joined up approach across the life course and to allocate adequate funding to support the development and evaluation and research around a national plan I agree with all the points that my colleagues have made but I just want to emphasise the point that Joyce made earlier on about co-producing solutions to this too much of what we do is top down is doing things to people rather than with people second point is to require the public sector to do what it can in places where it is entirely within their control Okay, thank you all very much That was very interesting this morning and thanks for attending Can I suspend briefly till we change the panel please? Okay Can I welcome to the committee Aileen Campbell Minister for Public Health Fergus Millan, Creighton Health, Team Leader Health Improvement Division and Derek Greave, Head of Active Scotland all Scottish Government Can I invite the minister to make an opening statement? Thank you for the opportunity to say a few words and I welcome the fact that the committee is taking time to look at what is probably the most pressing public health issue of our time and an issue that's not unique to Scotland but as usual we appear at the wrong end of the league table The Government approach to this issue is underpinned by a simple mantra one that holds true even as our understanding and knowledge of how to tackle this complex problem grows we all need to eat less eat better and be more active Obesity can reduce people's overall quality of life create a strain on health services and lead to illness and premature death due to its association with serious chronic conditions such as type 2 diabetes cardiovascular disease including hypertension and stroke and a range of cancers On its own the likely cost of diabetes to NHS Scotland is estimated at around £1 billion per annum and much of that is avoidable Obesity used to be an exception to the social patterning seen in other non-communicable diseases essentially every SIMD in Scotland was gaining weight however more recent years have shown some progress in more affluent communities at the same time as the prevalence of obesity in more deprived communities has increased and that can be seen particularly in the primary 1 data which highlights the divergence between the well-off and poorest in our society that may well be behind the plateau of the recent health survey data We published the prevention of obesity route map in 2010 and that established a solid base building on the foundations on diet and physical activity laid by previous administrations and we should recognise the good progress we have made in some areas for example on food and nutrition as well as physical activity Scotland's education system has a good story to tell the food served in Scottish schools has to meet high nutritional standards and implementation of curriculum for excellence we have made great strides in providing children and young people with the knowledge and skills they need to make healthy food choices coupled with that this government is delighted that 98% of primary and secondary schools across Scotland continue to provide at least two hours or two periods of PE which we know can have a positive impact on a pupil's health educational attainment and life chances however we are not complacent and the government will continue to provide schools and local authorities to drive improvements in school food and food education and having good strategies is important very important but clearly not enough and we do know that when we get our interventions right we can be outstanding but our response to obesity cannot rely on just a few projects no matter how impactful this is about reshaping the environment in which we live to make the healthier choice not just the easy choice but a change to our ways of living and inclusion the government recognises there are no silver bullets and we have to adopt an approach that focuses on a range of actions which will help deliver and support a wider cultural change to our lifestyle we recognise that there continues to be challenge in terms of seeing behaviour change on a scale large enough to make an impact tackling the obesogenic crisis and creating a cultural change cannot be delivered by the NHS or through public health alone we need wider society to see value in this and we need you and other leaders to reshape our relationship with food and activity so I therefore welcome this chance to discuss these issues with the committee as I prepare to consider how our policies should continue forward and how we in specific society can engage with the public in establishing the necessary culture change and I'm keen to bring coherence and clarity to our messages on obesity and I sincerely again look forward to working with you and the rest of the committee on this agenda so thank you minister the previous panel unanimously agreed it was an obesity crisis do you agree with that assessment? I think when as I outlined in my opening remarks the cost in terms of diabetes alone shows how much of a challenge and how much of a problem that persists in Scotland and that's despite I think some of your the previous panel suggested that despite having a number of the policies in place to try and tackle that so absolutely the scale of the problem that we face in Scotland is significant and we need to redouble our efforts in which we try and tackle that not just for the here and now in terms of the health benefits tackling obesity will create but also in the preventative sense that allows us to stop the impact that it's having on our health service and on public services more generally so absolutely there is a significant problem that Scotland has to face I'm asking not in any effort to embarrass you or anything like that but I think if we all accept that there is a crisis then that gets us to a starting point where we're all recognising the seriousness of it do you think that's an unfair word to use or is it accurate to reflect what you think? Again I'm not trying to deflect the seriousness of this I think that what we have in Scotland is a realisation across a number of different areas a number of different professions a number of different disciplines that this is something that we need to refocus and refresh and that's why we've committed to looking at the obesity and refreshing that strategy next year and that's why we're pleased that the committee is looking at this and the range of people you had thinking as we take that forward I think as others have said then the problem is significant in Scotland the seriousness of it is huge and we need to I think they'll also be mindful of our language as well because of the sensitivities around some of that and how people feel so I think your panel earlier decided that it was a crisis I think we all agree on that and we need to refocus refresh our approach making sure that we bring together not just leaders in yourselves as the committee but also civic society as well to make sure that we focus and face the same way in Scotland recognising that Scotland has to unpick generations now of overeating less activity and choices that are less healthy Thank you, convener Good morning minister Obviously before you took this brief you were the minister for children and young people and we did a lot of work together over a number of years in that regard I'm very glad about that because actually I think a lot of this agenda is about children and about prevention, early intervention the last panel we heard quite a lot about first of all place and promotion and in terms of place lack of availability access to fresh and nutritional ingredients and products but also advertising that a lot of our advertising is targeted at our young generations now obviously this Parliament is not entirely in control of advertising agenda but there are things we can do I just wonder if you would sketch out for us where you're coming from in terms of what you think we can do in this Parliament to reduce the exposure of our young people to marketing and promotions within our supermarkets and peer pressure and the rest of it Yes and certainly on the issue around promotion or marketing anyway I wrote to the UK Government to see if they would reconsider their position on advertising junk food advertising before the watershed I think we've yet to get a response to that request and if they don't reconsider it we would like to open up discussions around whether or not those powers could come to us but I think the point that you make is a good one and I think this chimes nicely with our refocus and our refresh on the beastie strategy because it will give us a chance and an opportunity in that more broader sense to look at ways in which we can take a lead but some of these things are tricky and I guess that's where it's useful to have this dialogue with you as the committee because Parliament wants to see us take this obesity strategy refresh about where the parameters might be where you would like us to focus our efforts on, where you think we should be taking a lead in the way that we can look towards public policy around minimum unit pricing or on tobacco as well, you know, Scotland took quite brave and bold decisions on those areas this is an issue that probably has a degree of greater sensitivity because a lot of time people will consider things like tobacco smoking over consumption of alcohol or something that somebody else does somewhere else we all eat there is a cultural change that we need across the country so there are greater sensitivities and of course some of those bolder policies have a degree of kickback so I guess it's useful to I suppose continue this dialogue continue that work to see where we should be pushing a wee bit more where Scotland can take the lead we're keen that we need to make a difference on this issue plateau on this issue as possibly the statistics might indicate we have and we need to consider everything as we look at our species strategy that we'll bring for consultation next year okay, bye thanks thanks minister for coming to talk to us there I want to focus on is round about the preventative area and preventative spending in particular and it was interesting that here in your opening remarks you put a number out there of a billion which was a dive-dibi to spend I'm just taking a step back the Christy commission talked about up to 40% of public sector spend was a consequence of things that could have been ffented earlier it's a big number I don't know if I'd buy into that but certainly that in the health budget would be somewhere north of 5 billion so I think your 1 billion we're starting to get into the right kind of ballpark which is good to hear and the reason I focus on that is because it informs where we spend money in a preventative sense but also we're happy to talk about how much more money we need when things are getting worse but should we turn the corner on obesity then in theory you would be freeing up resources which would be a nice place to be so I suppose I'd just like to reflect on what data you're aware of that is there that would allow us to inform that debate what the consequences of making improvements in that area would be financially and then the second part of it is the health one of the departments that suffers as a consequence of other things that happen across society and government you tend to pick up the pieces of things that are caused elsewhere in terms of the health outcomes how much across government working and how much support do you feel you've got because we talked this morning in those areas things in planning and transport potentially in education and regulation you name it have all got a downstream impact is that do you feel that's kind of coherent and joined up at a government level the Christie commission that was published I think now it was 2011 I think it was published so still relevant now challenged us all to work out how we move away from silo working move away from being doing progressing a stream of work in one area reflecting on the crossover with other areas and that was as much a challenge for the wider public sector as it is for government as well and so of course we work across the government which is why there is significant investment in active travel which is why there is significant investment in such trans and such like as well because we understand the need to be working across portfolios, across disciplines and across different boundaries national strategic group on activity also includes representation from SNH from Transport Scotland and others it's why the walking strategy is taken forward and is chaired by the group that chairs and leads the walking strategy is chaired by the chair of RTPI from the planning institute as well so there's areas we can point to where we're working with beyond the usual suspects and making sure that we're trying to make inroads into areas which need to understand that they have an impact on that public health agenda they might not clearly associate it with it but certainly I think that's part of why we need to build more momentum across the whole of civic society across the whole of the public sector to make sure that we can focus and face the same way to make the inroads into this area in the best way we can and also make sense in terms of working and collecting our resources together now can there be improvements in that and no doubt there can be, there has to be because your last panel as I was listening we're talking about the issues around implementation on the ground level so there's still a job of work for us to do to make sure that that's as cohesive as we can get it and of course they're probably we can do likewise always make improvements and always try to make improvements in our work across Government in terms of the end I think you know that's a clear clear one around the one billion spent on or the cost to type 2 diabetes you know some of those things are preventable if we can prevent them then that's a cost that we don't have to bear but you know at the same time preventative spend is always probably more easy to say than it is to kind of shift that focus shift that tank around to ensure that that's what we are doing because we're still having to deal with the fact that people now need to be helped to cope with their conditions so Christie commission is as relevant now as it's ever been we need to be more disciplined in our focus I think and we need to ensure that we use this opportunity and the refresh of the obesity strategy to make sure that we bring together across a number of disciplines to ensure that we get the impact that we want and that we seek thanks in your opening statement you acknowledge that there is a clear link between obesity and deprivation particularly amongst women and children if we just look at one example around fuel poverty if somebody can't afford to pay their gas bills can't afford to pay their electricity bills then obviously they can't afford to cook or prepare a healthy meal so why do you think the existing strategy has failed to make inroads when it comes to tackling obesity particularly in areas where we have the most deprivation there's probably a number of reasons as well and I think you probably alluded to there's generational issues there's probably educational issues and there's probably a whole host of other societal issues as well at play there too I don't think anyone is pretending that this is a simple or easy thing to solve and I think everyone recognises that the way in which our statistics indicate that there are particular problems in areas of deprivation show that we need to have a much stronger focus on making a difference in those communities likewise the fuel poverty issue the fact that people can't afford not just to buy the food but actually can't afford to cook the food either is something that we need to ensure is part of the focus going forward it has been a focus there has been attention there but clearly we need to demonstrate much greater improvement don't know of hair figures do you want to add anything? I also look after health and equality policy and one of the big pushes we tried over the last few years was to get the Government to take more attention to tackling inequalities and I think you see that that's happening and if you tackle inequalities a lot of things you would do to tackle inequalities will impact on people's health generally and it will impact on the beast so these all things go together so the work we've done in inequalities will contribute to that it's changed how we're approaching that it's changed and we'll see the results of that over the course of the next few years the figures at the moment show quite clearly that it's not having an impact that obesity levels in deprived areas are certainly growing I think that these sort of figures don't change dramatically overnight you're going to have to follow this trend and what you want to see is the movement of the figures over a course when we first started writing the obesity strategy in 089 for publication in 2010 inequalities wasn't deemed an issue as the minister said it affected everybody in Scotland there were some groups of people the women in particular were from 5 years were maybe outliers there but what we've seen over the last few years is the separation of the different SIMD zones and it's only appeared in the last few years and it's particularly apparent with children but if you actually look at adults they've not quite separated fully yet and it's interesting so maybe adults have taken on board some of the messages and particularly in the well-off communities they've taken on board the messages they're doing things for their kids but they aren't actually quite taken on board that message for themselves yet they're not committed to giving up their glass of wine at night or eating more healthily and their kids are doing it so that's said that adults are just not quite at the same place as the kids are so maybe there's a need to change when it comes to the refresh strategy there's a need to change the strategy or is it about the implementation of the strategy? We'd always said from the outset that we'd have a focus on inequalities we'd target our resources where we could and our activity are on those most deprived communities and that's what we've done so we've tried to do that anyway from the outset but you're not going to see immediate results very quickly and that's going to take decades to turn around In terms of targeting the areas of most need can you evidence that where that's happening where significant resource is being taken from one area and redirected into an area of most need? I can't give you that myself because the resources will go out to the health boards and out to the local authorities but we have policies that are continuing to make an improvement across the piece you know primary one to three now have free school meals, a nutritious meal the nutrition value of those meals is as good as it has been we have a number of areas of work around what we're trying to do in terms of encouraging activity as well and that's around making sure that it's accessible because of the suffer most deprivation but we also have to realise as well as I think your previous panel noted that the areas of deprivation are far more susceptible to some of the more difficult decisions that they're having to make making their income go further around choosing or being unnecessarily forced down a path where they sometimes take the unhealthy option to make sure that in this reef focus and the reef fresh that we do tackle inequalities that we understand the choices that families are having to make, find ways in which we can help them, the investment we're making around some of the allowing more deprived areas to have access to fresher healthier food has seen investment from the Government as well so those are issues that we've got policies in place we've invested in them to build upon that to make the difference that I think we all seek Do you want to come back in? Maybe a very good example is football fans in training which is obviously focused in on the football clubs and we've asked them from the outset to focus on people within their fan base from the more deprived areas which they're often drawn from and so that's a very specific example of where we're actually picking up people from that particular area and it's a very successful project Do you want to come back to that, Alison? Thank you for joining us this morning You'll be very well aware that Scotland has the worst weight outcomes of all UK nations so I very much welcome the minister's statement that this is the most pressing public health issue but I think it's fair to say that our previous panel would agree that it doesn't feel like a national priority Doctor Drew Walker pointed out that this is entirely preventable but it's costing the NHS hundreds of millions each year so I would like to ask and Professor Nanette Moutry made the point as well that we have lots of fantastic policy that we're simply failing to implement and we're not investing in it so I'd kind of like to understand what is going to change I mean we saw the complete removal of funding for jog Scotland we know that last year only 1.2% of journeys in Scotland were made by bike we have a vision for that to be 10% by 2020 and the minister spoke of significant investment in active travel but I'd also like to ask the minister if talking about a cross cutting portfolio will you be speaking to Humza Yousaf and perhaps suggesting that he invests more than well less he currently invests less than 2% of a very big transport budget on walking and cycling are those the kind of changes that we can expect to be put in place already invest significantly significantly in active travel a record investment of 39.2 million per year in active travel and continue to do that and continue to make the investment and of course we'll continue to have discussions with other policy leads and other ministers with other areas of interest that relate to helping us tackle this problem of obesity a lot of the evidence and investment stack up to that cross cutting nature now can there be improvements of course there can be improvements and we'll continue to need improvements but actually in terms of walking there has been a great improvement through having that focus on walking we have seen an increase of around 5% in walking and a reduction in the weight of people participating in walking as well so there's a clear indication of where government does put a focus quite quick results even though the longer term benefits will be a wee bit further down the road before we start to see the impact across the country but we are investing in areas like active travel making sure that we do work across portfolios and we'll continue to make sure that the policies that we have can be implemented and can feel the impact of that in a positive sense across the country I think of just making the point that perhaps ministerial colleagues and it might be 39 million may be a record for this government but I would still suggest that it is far too low given that 50% of Scots as we know don't have access to a car I think really suitable appropriate investment in this area could help address inequality markedly we know from international evidence that in countries where a lot of people cycle it's those on the lowest incomes who tend to gain most advantage and if we look at the Jog Scotland programme for example, there's a lot of evidence to suggest that that was very good at addressing inequalities lots of people who took part in that programme are perhaps women in their 40s who might not be comfortable about attending a gym they like the fact that the costs were low that they could do it in their own neighbourhood so that's exactly why we've had a focus on the walking strategy walking is free of charge but we have to make the conditions right for people to participate but I think that's a positive thing that Scotland has seen a 5% increase in walking and as a result of a cross portfolio focus on trying to improve upon where we have been and that, as I said the walking group that we have that strategic group is chaired by the chair of RTPI so again that's bringing planning into this as well nobody's saying these things without understanding and being cognisant of the improvements that we need to make and continue to make as well about making sure that things like active travel are much more keenly and routinely felt within the planning decisions that are getting taken as well so we have to make and it's across not just public health it's across the whole of wider civic society and public life more generally but I think that we can point to areas like walking which is free of charge which we have invested in to ensure that we can allow more people to participate in this pastime which improves their fitness their wellbeing and helps us tackle some of these problems that we're facing Can I just ask them Professor Nanette Moutry made the point that she thinks that there's a lot of very good policy out there and clearly there have been improvements which I warmly welcome to but there was a feeling from the panel that they're not being implemented because they're sourcing now clearly local authorities budgets have suffered how does the minister how will you enable local authorities to deliver some of these programmes given that reduced budget Local government has been given a settlement that's fair that's not to take away the fiscal challenges that everybody across public life is facing I think going back to Christie the principles of the Christie commission I think that means that we have to acquire a much more disciplined approach that will bring our collective resources to bear to make the improvements that we need to make Alec Cole-Hamilton in his earlier line of question and talked around the early years work that we took forward together when he had his role in Aberlywyr, one of the things around the early years task force was about bringing together local government NHS and government together to pool our resources a bit more effectively that's one example of where that can bring about the differences that I think we need to see but I think in terms of your point there I think that's why we need to probably push a bit more and work much more collaboratively with local authorities, with the NHS and others bring about bring together our resources and work out where we'll have the greatest impact and some of the things that we're talking around like walking around the football fans and training cost effective and don't cost a huge amount so sometimes some of the solutions some of the answers don't cost a huge amount but that impact can be quite transformative so I think it's around working together more collaboratively working together with a common purpose with an understanding of what we want to do and what we want to achieve and I think that's where the opportunity for the refresh strategy will take us when we go out to consultation about what are the things that Scotland needs to do differently in order to make the impact that we need Thank you Can I have on this local government fairness thing Can I ask if it's fair that my local authority in West Lothian which was named UK Council of the Year in 2006 for being an effective well-run local authority has had 90 million taken from his budget impacting on active travel pensioners groups physical activity groups sport all of that stuff that feeds in to this very important issue that cannot be fair surely The Scottish Government's budget has been cut as well and actually what we've managed to do though is to provide a settlement for local government which is fair it's not diminishing the financial challenges that we all face but the Government has provided a fair settlement for the local government in the backdrop of its own budget being cut considerably from Westminster The previous panel touched upon the health and child health surveillance data which we use and how that's reformed as part of the refresh strategy do you agree that maybe we should look at introducing secondary school level data to be recorded as well and on a separate point you mentioned that 98% of pupils are now receiving two hours of physical education in school, do you think that that's actually quality PE in those cases I heard the comment made and I think certainly the consensus of opinion from your previous panel seemed to suggest that they thought that this would be a good idea to embark upon the monitoring at secondary school level of children's or young people's weight to look at and considering as well in terms of the quality we've come from a base of 10% in 2004-5 up to 98% now that's a huge and significant increase that I don't think we should take away from this has been work in progress between our active schools with Sport Scotland and the Scottish Government that I believe is there Derek, do you want to? I'm enrolling out and increasing the delivery of the PE target Education Scotland colleagues work very closely with schools so as well as increasing the volume there's been a lot of work both within schools and across schools to ensure that quality is driven up as well Richard Thank you very much convener, morning minister you said earlier that the public accepted several laws that the Government has brought in over the last couple of years are one of which is still on-going minimum pricing smoking etc the question I want to ask you is the previous panel basically was suggesting that we should regulate the food industry and especially the big names the Tescos, the Sainsbury's bring in taxes which I don't think they're going to like too much if we did what's your view should we regulate or educate people in regards to this if you want to call it some people are this crisis I certainly think we should educate regardless of anyone's views and opinions on the regulation and we strive to do so through curriculum for excellence and through a whole host of other areas as well and that extends beyond the school, classroom and youth work in a whole host of other sectors which take their responsibility seriously around the children and young people in their care I think around the regulation I think you touch upon an issue that shows how complicated this issue and the area of policy is I think when you look at the minimum unit pricing when that was something that wasn't supported necessarily wholly by constituents of the industry I think it shows the trickiness in trying to move forward in these areas so what I think we need to do and what I think the strategy of refocusing refresh will allow us to do is to have that wider debate about where civic society wants to push us where does the committee want us to go what are your thoughts as leaders within your own parties and within your own communities as well what are the areas that you think should be looking at as we try to find solutions and find ways to solve this problem that is significant to Scotland and is costing our public services a significant amount of money I certainly think as a starter we should be looking at the ensuring that the junk food advertising is not being exposed to children before the watershed I think that that would be something that would be quite straightforward has been called for by not just us in the Scottish Government but our counterparts in other areas of the UK and other health professionals across the UK as well so I think I would hope that the UK Government can reconsider this and that we can meet progress on that What role do you think that Food Standards Scotland and shops and the big grossers in formulating and promoting a better healthier way of eating They have a national leadership role as well a role to provide authoritative sources of advice and evidence and to work with other partners about trying to ensure that there is clear guidance around people's approaches to purchasing or people's approaches to food more generally and they are also well placed through that separate role a separate position that they have to government to provide challenge to industry as well so they have an important role to play If you allow me to convene one last question We are talking about the sugar tax drinks etc What do you think about a levy on unhealthy foods? Against some of these issues no doubt will come out through the consultation that we take forward but what was clear from your last evidence session is that there is a desire there for Scotland to be bold on this issue where we have seen that boldness around tobacco and alcohol we have seen that the health benefits have come through so this is an opportunity to really flush out what things people think that we should be doing where we need to increase our efforts what more we need to do how do we properly implement some good policies that we have there in place but also we have to work and be mindful of some of the sensitivities that exist there and it's not going to be an easy area or an easy journey to embark upon but I think the consultation gives us a chance to think openly about what tools we have what tools can make a difference and how we choose to proceed forward and trying to cope and deal with this issue that Scotland has around obesity Thank you, Claire, then Alex Thank you minister for joining us this morning and we heard from the earlier panel their concern about price promotion on some of these higher sugar higher calorie foods and I was quite staggered by some of the figures in the cancer research paper 53% of regular soft drinks were purchased as a result of price promotion I wonder if the minister could perhaps give us our thoughts on price promotion here we've at the Scottish Government looked at price promotion particularly with alcohol and multi buys and perhaps this would be something that they would give some consideration to with regards to sugary drinks high sugar and high fat dense high calorie foods Absolutely we'll consider that as part of the strategy and the consultation that we'll embark upon I think even seeing the talk of the sugar levy we're beginning to see some change behaviour from industry I think Tesco are starting to reformulate Lucasade I think from memory as well as another example so there's already changes in industry at the moment through the notion of the sugar levy so absolutely we'll consider that as part of the refresh on the strategy I'd like to draw on Miles Briggs' question and again you might want to reflect on your experiences as minister for children young people in your answer on this as well I think it's fair to say that the SNP ought to be what happened in the PE and that draws cross-party support in terms of the 98 per cent now getting in two hours a week but I think that whilst this government has given with one hand it's arguably taken away with the other in terms of the decline in access to youth work that children and young people have so for those crucial times out of school hours the access to physical activity things like the decline of the community education department youth workers in the way that we were anymore and still we have this repeated barrier across our communities where brilliant facilities are inaccessible on weekends due to being tied up with other sporting and clubs events or they're just financially prohibitive what steps will your government take to mitigate that and to promote and boost access to youth work okay well we have in terms of youth work I think that Scotland takes a lead in comparison to many other parts of the UK around our approach to youth work and our strategy our youth work strategy and participation in a number of different from memory the uniform groups for instance is going up as ever when things around youth work the problem is trying to always entice volunteers to come forward as well so that they can provide those opportunities too ensure that that continues and we have I think quite a good story to tell around youth work sorry you want to come back I absolutely agree we've got a really shiny strategy about youth work but unfortunately with the cuts to local government we're seeing paid youth workers laid off we're seeing diminished access rolling we had a really good meeting in Muirhouse community in my constituency last week with a number of youth work providers all of whom are uncertain as to whether they will still have contracts this time next year because of local government financial uncertainty now I admit that's a decision that's taken at a local level but that's about funding priorities from this government as well so whilst the strategy is brilliant delivery on the ground isn't meeting that we can point to increased participation and amongst some of the youth work organisations as well and we do have a good strategy in place and we have seen great improvements in youth work as well participation in youth awards as well has gone up exponentially as well which is accredited across by the SQA and we also have in this portfolio the active schools network as well which is providing greater opportunity for young people in a community sense as well also we met and exceeded our target for community hubs which has been taken forward by Sport Scotland as well and as they move forward in terms of trying to further increase the number of community sports hubs we'll be looking at ways in which we can look to areas of increased deprivation around how we can enhance and increase the opportunities that young people have to participate in sport and participate in activity more generally as well we have some of the best facilities that we've ever had across the country now we have to make sure that we're breaking down those barriers to ensuring that everybody gets an opportunity to use them but I think that with this work we have a good story to tell in our active schools network we have another equally positive story to tell as well which has been also enhanced by the community hubs which have seen a significant investment from Sport Scotland and the Scottish Government to ensure that young people in areas across the country have access to a variety of different sports of their choice I was struck when we were looking at the evidence that was submitted that there are probably slightly different strategies required in terms of preventing obesity and in terms of tackling obesity so when it comes to actually treating the obesity and overweight problem that we have at the moment more significant is reducing the number of calories that people eat so affecting the diet rather than the level of activity so I accept that physical activity can be part of the treatment strategy but much more significant and much more bang for our back in terms of affecting policy would be tackling what we are actually eating I would be interested in hearing your thoughts on that I was also struck when we were speaking earlier about the previous panel about the previous strategies may have actually increased health inequality because many of them were targeted at individual responsibility and it may be time to be thinking very seriously about population level approaches fiscal strategies and regulation in terms of not further broadening that inequality gap I think physical activity has to be part of our approach and I know that there are lots of different views and opinions but I think as well the wider benefits that physical activity provides around mental health general wellbeing and also and while a lot of the focus can be around young people and girls there's also the older cohort as well around the necessity for older people to be active as well helps with fall prevention helps with their muscle tone and a whole host of other things and that's a bit of work that we're continuing to do with the care inspector and others around care homes as well so there's bits of work happening in other parts of the age groups that we need to have a focus and attention on so I think absolutely for me it has to be part of our approach as well as looking at what people eat because physical activity in itself is not going to be enough to outdo the calorie intake that people are consuming and you're right as well around some of the issues around being there being good policies and good pockets of practice in different places how do we scale that up so that has to be part of our approach as well about how we make that population level change but again going back to the walking, that 5% increase as well, that's through a lot of collaborative work, a lot of focus on an issue, an area that we know can make a difference and then we've seen that difference happen quite quickly so while some of the benefits are going to be felt longer term we can make inroads and have some quick wins and that short, medium and longer term those goals will need to be how we move forward with the strategy refocus As you said you wanted to hear the committee's views on how we take this forward, I'd be also keen to hear your views on that if we look at the issue of smoking and alcohol Governments took I think brave and bold decisions taken on invested interests in order to move that agenda on I think in order to really get into this and start to make impact we need to take on some of those vested interests again now some of the issues you mentioned lie with the UK Government but there are issues lying with the powers in this Parliament so what I'm really asking is your view as to whether what you would say to my question which is are you going to take on those vested interests with the powers that you have here in order to make a real impact on some of the issues that we've been discussing this morning and continue to lobby elsewhere where that's required I think that's why the obesity strategy moving forward is going, the opportunity that we have to have that dialogue and that consultation in the run-up to this strategy is so important because I guess that will allow us to look for ways in which we can be innovative and bold and make the differences that we seek to bring about but that is going to be it's going to be quite a challenge and that's why I was asking suggesting that the committee might want some of their views and opinions as well because at this point in time we're quite open-minded but we have a determination to make a difference and we'll need to roll up our sleeves and if there are ways in which we can bring about the changes around the problems that Scotland faces with obesity then we'll have to look seriously and look hard at how we manage that and how we move it forward but this the areas around minimum unit pricing that was a, the whole Parliament came behind some of those bold decisions and bold moves and I think that's where we need to be as well and be mindful that this isn't just about one in hearts and minds here in the Parliament but this is about the wider society as well and the sensitivities around looking at bulk buys, looking at the price and some of these things are going to be quite difficult and challenging topics but we have I think a collective determination to make the improvements that we need to see in Scotland and that the public purse is feeling and facing at the moment so I think the opportunity lies around the consultation and the strategy and gives us a chance to raise the dialogue and raise the debate around what we do as a country and how we approach and how we respond to the problems that Scotland is facing Okay, Andy, want to make any final point? Nope Okay, thank you very much for your attendance this morning I appreciate that and we'll suspend briefly Thank you Sorry, we're now going to private session Sorry